MEDICARE: PROHEALTH MEDICAL GROUP INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207V00000X	Obstetrics & Gynecology Physician
2	208600000X	Surgery Physician
3	207W00000X	Ophthalmology Physician
4	208800000X	Urology Physician
5	261QM1300X	Multi-Specialty Clinic/Center
6	207K00000X	Allergy & Immunology Physician
7	207R00000X	Internal Medicine Physician
8	207X00000X	Orthopaedic Surgery Physician
9	207Y00000X	Otolaryngology Physician
10	207N00000X	Dermatology Physician
11	207Q00000X	Family Medicine Physician
12	208100000X	Physical Medicine & Rehabilitation Physician
13	261QR0200X	Radiology Clinic/Center
14	2084N0400X	Neurology Physician
15	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1356322440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	N17W24100 RIVERWOOD DR
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53188-1177
Country	:	US
Telephone Number	:	262-928-4100
Fax Number	:	262-928-5835

Provider Business Practice Location Address
First Line	:	N17W24100 RIVERWOOD DR
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53188-1177
Country	:	US
Telephone Number	:	262-928-4100
Fax Number	:	262-928-5835

Authorized Official
Title or Position	:	REIMBURSEMENT MANAGER
Name	:	THOMAS W JOHNSON
Credential	:	MD
Telephone Number	:	262-928-4704

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	06/18/2026

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Practice Location Address:

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